Long-term valacyclovir treatment and immune modulation for Herpes-associated erythema multiforme.

OBJECTIVE: Erythema multiforme (EM) is an immune-mediated condition characterized by the appearance of target-like lesions on the skin and often accompanied by erosions or bullae involving the oral, genital, and/or ocular mucosae. 70% of recurrent EM cases are associated with HSV reactivation and it is labelled as herpes-associated erythema multiforme (HAE M). Recurrences are seen in approximately 20-25% of EM cases and managing these conditions are challenging for both the patient and the doctor. The effectiveness of antiviral drugs is proven for Herpes simplex infection, however most patients use a multiplicity of alternative and complementary therapies. CLINICAL PRESENTATION: We present clinical data of 3 patients with recurrent HAE M managed by long-term valacyclovir therapy and immunostimulation with Echinacea or replacement immunoglobulin therapy in the case of IgG1 subclass deficiency. The presented cases have demonstrated that immune mechanisms are relevant for HAEM recurrences. CONCLUSIONS: The immune abnormalities, such as antibody deficiency, in the patients with HSV-associated EM can lead to frequent relapses of disease and should be evaluated. Long-term antiviral therapy with immunomodulation can control the relapses of HAEM.

Wheat-dependent exercise-induced anaphylaxis following laparoscopic adjustable gastric banding procedure associated with Helicobacter pylori infection.

Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a special form of adult food allergy when allergic symptoms are elicited when triggering factor such as exercise is added after ingestion of wheat. Besides the molecular characteristics of wheat proteins, the gastric function is decisive for the allergenic potential. Alterations in the gastric milieu are frequently experienced during a lifetime either physiologically or as a result of gastrointestinal pathologies. Helicobacter pylori infection can lead to hypoacidity and enhance the sensitization risk for food allergens in adults. Gastric transit of food proteins and alterations in the gastric secretion can be disturbed after bariatric surgery such as the laparoscopic adjustable gastric binding (LAGB) procedure used commonly as therapy for morbid obesity. We report a case of WDEIA in a 42-year-old man with H. pylori positive gastritis, 2 years after bariatric surgery and no history of allergy previously. Our presented case strongly suggests that H. pylori-associated gastritis and gastric anatomy and functional changes after adjustable gastric banding lead to the alterations in gastric milieu and may contribute to a development of food allergy in previously non-sensitized patients.

An Unusual Regression of the Symptoms of Kartagener Syndrome

El síndrome de Kartagener es una enfermedad genética poco frecuente que se hereda de forma autosómica recesiva, con una afectación progresiva del sistema respiratorio y situs inversus. Aunque el tratamiento de los pacientes con el síndrome sigue siendo poco claro y las pruebas disponibles son limitadas, es importante su seguimiento con una asistencia adecuada y compartida. En el presente informe se describe un caso clínico del síndrome en una mujer de 25 años de edad. La tomografía computarizada demostró dextrocardia y bronquiectasias. La radiografía simple y la ecografía abdominal confirmaron un situs inversus total. Después de 7 años, se obtuvieron resultados satisfactorios del tratamiento: la función pulmonar mejoró y en la exploración radiológica no se demostraron cambios. En el presente artículo se describe la compleja interrelación entre la variación genética y un tratamiento inespecífico apropiado del síndrome(AU)

Kartagener's syndrome is a rare autosomal-recessive genetic disease with progressive damage of the respiratory system and situs inversus. Although the management of patients with Kartagener's syndrome remains uncertain and evidence is limited, it is important to follow up these patients with an adequate and shared care system. This report presents a clinical case of Kartagener's syndrome in a 25-year-old woman. Computed tomography showed dextrocardia and bronchiectasis. Abdominal X-ray and ultrasound confirmed situs inversus totalis. After 7 years, good treatment results were achieved: lung function improved and radiological findings showed no changes. The present case discusses the complex interrelationship between the genetic variation and a proper nonspecific management of Kartagener's syndrome(AU)

An unusual regression of the symptoms of Kartagener syndrome.

Kartagener's syndrome is a rare autosomal-recessive genetic disease with progressive damage of the respiratory system and situs inversus. Although the management of patients with Kartagener's syndrome remains uncertain and evidence is limited, it is important to follow up these patients with an adequate and shared care system. This report presents a clinical case of Kartagener's syndrome in a 25-year-old woman. Computed tomography showed dextrocardia and bronchiectasis. Abdominal X-ray and ultrasound confirmed situs inversus totalis. After 7 years, good treatment results were achieved: lung function improved and radiological findings showed no changes. The present case discusses the complex interrelationship between the genetic variation and a proper nonspecific management of Kartagener's syndrome.

Translation, cross-cultural adaptation, and validation of the sino-nasal outcome test (SNOT)-22 for Lithuanian patients.

The objective of this study was to perform translation, cross-cultural adaptation, and validation of the SNOT-22 in the Lithuanian language. This is a prospective case-control study. The study was conducted at the University clinic. The sino-nasal outcome test 22 (SNOT-22) was translated into the Lithuanian language; the pilot study involved 34 patients, the test-retest group consisted of 34 patients with chronic rhinosinusitis (CRS), and the control group of 115 patients with no CRS complaints; 36 patients were evaluated before surgery and 3 months after surgery. The results showed a good internal correlation with Cronbach's alpha-0.89 in the initial test, and 0.93 in the retest; both values suggesting good internal consistency within the SNOT-22. Pearson's correlation coefficient was 0.72 (p < 0.001), revealing good correlation between the initial scores and the retests scores. Our sample of healthy individuals had a median score of 12 points, and the instrument was capable of differentiating between the healthy and the patient group, demonstrating its validity (p < 0.0001). The statistically significant reduction in the post-operative scores, vis-à-vis pre-operative values, demonstrates the responsiveness of the instrument. The minimally important difference was 13 points in the SNOT-22 score. The Lithuanian version of the SNOT-22 is a valid instrument for assessing patients with CRS. It demonstrated good internal consistency, reproducibility, validity, and responsiveness.

Association of chronic rhinosinusitis with nasal polyps and asthma: clinical and radiological features, allergy and inflammation markers.

Chronic rhinosinusitis (CRS) with and without nasal polyps represent different stages of one chronic inflammatory disease of the mucosa of the nasal cavity and paranasal sinuses. Coexistence of chronic rhinosinusitis with nasal polyps and asthma and rather similar characteristics of inflammation support assumption that chronic rhinosinusitis and nasal polyps and asthma may be, at least in part, the same disease process. We therefore aimed to evaluate the differences of sinus radiologic findings, systemic inflammation and allergy markers, pulmonary function of chronic rhinosinusitis associated with nasal polyps and asthma. A total of 121 patients with chronic rhinosinusitis referred to tertiary center were evaluated; 23 healthy persons served as controls. Sinus CT scans and nasal endoscopy were performed. Allergic rhinitis was diagnosed according to history and positive skin prick tests to common inhalant allergens. Asthma was diagnosed according to GINA by history and pulmonary function tests. Aspirin intolerance was assessed by history. Total IgE, Aspergillus fumigatus-specific IgE levels, leukocyte and eosinophil count in the peripheral blood were measured. Nasal polyps were detected in 84 patients (69.4%), asthma diagnosed in 48 patients (39.6%), associated with nasal polyps (91.7%) and allergic rhinitis in 45.5% of patients. Forty-four patients with chronic rhinosinusitis and having nasal polyps and asthma were characterized by older age (P<0.01), greater duration of nasal symptoms (P<0.001), higher number previous surgeries (P<0.01), more severe sinus disease on CT scan (P<0.001), greater blood leukocyte and eosinophil count, total IgE level (P<0.01), bronchial obstruction (P<0.05), incidence of allergic rhinitis (P<0.01), and sensitivity to house dust mite D. pteronyssinus (47.7%, P<0.01) and mold allergens (29.5%, P<0.01) comparing to the patients with isolated chronic rhinosinusitis. The extent of sinus CT changes was greater in asthmatics and correlated with greater duration of asthma (P<0.0001), higher number of previous surgeries (P=0.001), leukocyte count in blood (P=0.025), and age (P=0.039). CONCLUSION. Our data indicate that patients with chronic rhinosinusitis compose clinically heterogeneous group and when associated with nasal polyps and asthma constitutes the most severe form of unified respiratory tract disease, which is characterized by older age of the patients, greater duration of nasal symptoms, extent of sinus radiological changes, more prominent systemic inflammation markers, greater bronchial obstruction, incidence of perennial allergic rhinitis.

[Influence of sensitization to pollen and food allergens on pollinosis clinical symptoms]. / Ziedadulkiu ir maisto alergenais isijautrinimo itaka polinozes klinikiniams pozymiams.

UNLABELLED: Geographic position and local plants of the country influence the profile of sensitization of the population to airborne allergens. The aim of this study was to evaluate the sensitization pattern to pollen and food allergens in adult patients with pollinosis in Lithuania. 101 patients (age 16-63 years) suffering from seasonal allergic rhinitis and 23.8% of them also diagnosed with concomitant seasonal asthma were investigated. Oral allergy syndrome (OAS) was diagnosed in 29.7% of cases. The sensitization to 21 species of tree-, grass- and weed-pollen and plant food allergens was determined by positive skin prick and prick-prick test. In serum levels of total IgE and timothy and orchard grass specific IgE were determined by immunoenzyme assay. 52.5% of patients suffered from spring-summer pollinosis. 91.2% of patients were sensitized to grass-pollen allergens, 79.3% -to tree pollen-allergens. 74.7% of patients were allergic to weeds. Pollinosis starting in the spring and lasting more than sixteen weeks was associated with increased probability of OAS (OR=7.1, p<0.001 and OR=3.1, p=0.01). Sensitization to hazelnut (OR=8.6, p=0.009), birch (OR=9.6, p=0.07), lamb's quarters (OR=5.2, p=0.04) allergens and twofold and more increase in serum IgE (OR=4.8, p=0.03) were considered the significant risk factors for pollinosis with OAS. More than two times elevated serum IgE increased the probability of seasonal asthma (OR=3.4, p=0.03). Sensitization to ragweed was associated with decreased risk for asthma (OR=0.26, p=0.03). CONCLUSIONS: Our data indicate that more than a half of patients (52.5%) had pollinosis symptoms during spring and summer seasons because of multiple sensitivity to pollen allergens. Sensitization to hazelnut, birch, lamb's quarters allergens, more than two times elevated serum IgE are significant risk factors for pollinosis with OAS. More than two times elevated serum IgE increased the probability of seasonal asthma, but sensitization to ragweed was associated with decreased risk for pollinosis with asthma.

[The immunological parameters and risk factors for pollen-induced allergic rhinitis and asthma]. / Ziedadulkiu sukelto alerginio rinito ir bronchu astmos imunologines savybes bei rizikos veiksniai.

UNLABELLED: Naturally occurring exposure to pollen allergens causes symptoms of allergic rhinitis, conjunctivitis and asthma in susceptible individuals. It is, however, unknown why some subjects develop only an allergic rhinitis while others develop asthma as well. The aim of this study was to investigate the difference of immunological parameters in patients with pollen-induced seasonal allergic rhinitis (SAR) and asthma and to determine the risk factors for pollinosis with asthma. We evaluated the demographic and clinical characteristics of the patients, sensitisation pattern to tree-, grass- and weed-pollen and perennial inhalant allergens according to skin prick tests, allergic inflammation parameters (blood and nasal eosinophil count, serum IgE, eosinophil cationic protein levels) in and out of the pollinosis season. Logistic regression analysis was used to rate the effect of covariates on risk for pollinosis and asthma. One hundred and one patients (52 men and 49 women) aged 16-63 years (median 24 yrs.) with pollinosis symptoms were investigated. All patients suffered from moderate-severe seasonal allergic rhinitis, 96% from concomitant allergic conjunctivitis, 23.8% had seasonal asthma. The significant clinical and demographic risk factors for pollinosis with asthma were smoking (OR=15.4, p=0.003) and pollinosis season lasting more than 14 weeks (OR=5.6, p=0.02). The patients with seasonal allergic rhinitis alone were significantly more frequently sensitized to orchard grass (p=0.005), ragweed (p=0.02), lamb's quarter (p=0.05) allergens. During the season the blood eosinophil count raised in all patients (p<0.01). It was shown statistically that there were no differences between groups in blood and nasal eosinophil count, serum eosinophil cationic protein level. The patients with seasonal allergic rhinitis and asthma had higher levels of serum IgE during the season (p=0.05) and out of it (p=0.01). More than two times elevated serum IgE in acute and symptom-free period of pollinosis was considered as a significant risk factor for pollinosis with asthma (OR=3.5, p=0.04 and OR=3.4, p=0.03). CONCLUSIONS: Pollinosis presented with seasonal asthma in 23.8% of cases. Our data indicate that patients with seasonal allergic rhinitis and asthma differ from the patients with seasonal allergic rhinitis alone according to higher serum IgE levels. Prolonged pollinosis season, smoking and high IgE levels increase the risk for seasonal asthma in pollen-induced allergic rhinitis subjects.